Chronic suprapubic catheterization can be safe for patients with spinal cord injuries

Last Updated: 2008-06-11 12:16:14 -0400 (Reuters Health)

NEW YORK (Reuters Health) – Complications with chronic suprapubic catheterization for bladder management in spinal cord injury patients may not be as common as previously believed, and the strategy can be a safe option for selected patients who prefer it, according to a report in the June issue of BJU International.

Intermittent self-catheterization is generally recommended for management of these patients, the authors explain, but many patients prefer chronic suprapubic catheterization (SPC) because of quality-of-life issues.

Dr. Takayuki Sugimura and colleagues from Christchurch Hospital, New Zealand assessed the incidence of significant urinary tract complications in 149 newly diagnosed patients with spinal cord injury who were started on SPC management..

Almost half of the patients had no complications during a mean follow-up of 68 months, the authors report.

Forty-five patients (27%) had symptomatic urinary tract infections (38 with cystitis, eight with acute pyelonephritis, and three with epididymo-orchitis), the report indicates, and 33 patients (22%) developed bladder stones.

Overall, 20 patients experienced 22 renal complications, the researchers note, including nine patients (6%) who developed renal scarring, which was moderately severe in only one patient.

Vesicoureteral reflux developed in 21 patients, only five of whom experienced upper tract complications (renal stones in three, renal scarring in one, and both renal scarring and stones in one).

"The risk of symptomatic urinary tract infection and bladder stones is higher than with intermittent self-catheterization or reflex voiding," the investigators say. "However, these manageable complications are acceptable to some patients who prefer SPC, and in the present series there was no significant risk to upper tract function by pursuing this policy."

They conclude: "The incidence of significant complications might not be as high as previously reported, and with a commitment to careful follow-up, SPC can be a safe option for carefully selected patients if adequate surveillance can be ensured."

BJU Int 2008;101:1396-1400.